KR20040007617A - Orally Administering Parathyroid Hormone and Calcitonin - Google Patents

Abstract

The present invention relates to a method for oral administration of PTH comprising orally co-administering an effective amount of PTH and an effective amount of calcitonin to a patient in need of the parathyroid hormone PTH. The method of the present invention allows oral administration of PTH without the side effects of hypercalcemia, hypercalciuria and nephrolithiasis.

Description

Oral Administration of Parathyroid Hormone and Calcitonin {Orally Administering Parathyroid Hormone and Calcitonin}

PTH studies in animals and humans using PTH, PTH-related peptides and PTH homologues have demonstrated their usefulness in increasing bone formation and bone resorption and call for interest in their use in the treatment of osteoporosis and related bone diseases. It became. However, the clinical utility of PTH is limited by the occurrence of hypercalcemia, hypercalciuria and nephrolithiasis. The incidence of these potential toxic side effects and alteration of calcium metabolism remains a barrier to exploiting the benefits of higher doses of PTH, and in terms of safety, there has been a demand for plasma concentrations of PTH to be present within a narrow band. The range of therapeutic limits for oral PTH therapy can be increased if the hypercalcic effects mediated mainly by osteoclasts can be separated from the osteogenic effects mediated mainly by osteoblasts. In contrast to PTH, calcitonin interacts directly with osteoclasts, thereby reducing serum calcium concentrations by decreasing bone resorption surface area and net bone resorption by osteoclasts. Because of the decrease in plasma calcium concentrations, urine calcium levels, which are a known risk factor for nephrolithiasis, correspondingly decrease. The present invention describes a method of oral PTH administration that broadens the therapeutic limits for PTH administration and enables oral administration of higher PTH doses without potential toxic overcalcium side effects.

Summary of the Invention

Accordingly, the present invention relates to a method for oral administration of an effective dose of PTH comprising orally co-administering an effective amount of PTH and an effective amount of calcitonin to a patient in need thereof.

Administration of PTH to primates increases the plasma concentrations of serum parathyroid hormone and serum calcium. Conversely, administration of salmon calcitonin (sCT) to primates increases serum sCT concentrations and decreases serum calcium. Oral administration of PTH and calcitonin in combination in accordance with the present invention results in surprisingly reduced serum calcium concentrations than levels obtained using calcitonin alone, while the levels of PTH and calcitonin plasma are similar to those achieved when administered alone. It turned out. In fact, calcitonin counteracts the hypercalcium effects of PTH while achieving the same reduction in serum calcium obtained when calcitonin alone is administered in the absence of PTH. Administration of calcitonin in combination with PTH therapy allows for the additional therapeutic effect of the currently excluded PTH dose without overcalcium side effects. In addition, calcitonin provides a beneficial analgesic effect in offsetting bone pain that is normally associated with administration of PTH.

The invention also relates to a new method for stimulating bone formation, comprising orally administering a therapeutically effective amount of PTH and a therapeutically effective amount of calcitonin to a patient in need of new bone formation.

In a further embodiment, the invention relates to a method for treating or preventing osteoporosis, comprising orally administering a therapeutically effective amount of PTH and a therapeutically effective amount of calcitonin to a patient in need thereof.

The present invention also relates to compositions suitable for oral delivery, including, for example, simultaneous monosynchronous, concurrent or continuous administration of PTH and calcitonin.

The invention also relates to the use of PTH and calcitonin in the preparation of new oral administrable medicaments for stimulating bone formation, for example for simultaneous monomorphic, simultaneous heterologous, or continuous administration of PTH and calcitonin.

The present invention also relates to a novel osteogenic stimulation kit comprising, for example, simultaneous monomorphic, simultaneous heterologous or continuous administration of PTH and calcitonin, together with instructions for oral administration of PTH and calcitonin suitable for oral administration.

Further features and advantages of the invention will be apparent from the following detailed description of the invention.

The present invention relates to oral delivery of parathyroid hormone (PTH). More specifically, the present invention relates to the use of calcitonin with PTH for oral administration of PTH.

Parathyroid hormone or PTH can mimic hPTH (1-84) activity in the regulation of calcium and phosphate metabolism to form the human body hPTH (1-84) or human body bones, such as the full-length 84 amino acid form parathyroid hormone Any polypeptide, protein, protein fragment or modified fragment that is present, ie, PTH-related peptides and PTH analogs. PTH fragments can generally incorporate the first 28 or more N-terminal residues, and PTH (1-28), PTH (1-31), PTH (1-34), PTH (1-37), PTH (1 -38) and PTH (1-41) or homologues thereof, such as PTS893. The PTH can be a single PTH or any combination of two or more PTHs. These parathyroid hormones are either commercially available or recombinantly obtained by peptide synthesis or extracted from human milk by methods well established in the art.

Calcitonin for use in the present invention may be any calcitonin, including calcitonin derivatives such as 1,7-Asn-eel calcitonin, as well as its natural, synthetic or recombinant sources. Various calcitonins, including salmon, pig and eel calcitonin, are commercially available and are commonly used in the treatment of, eg, Paget's disease, malignant hypercalcemia and osteoporosis. Calcitonin may comprise a single calcitonin or any combination of two or more calcitonins. Preferred calcitonin is synthetic salmon calcitonin.

Calcitonin is commercially available or can be obtained by known methods.

The amount of PTH to be administered is generally the amount that effectively stimulates new bone formation, i.e., a therapeutically effective amount. This amount will of course vary depending on the age, size, sex and symptoms of the subject to be treated, the nature and severity of the disease to be treated. However, the amount may be small when multiple compositions are administered, ie the total effective amount may be administered in cumulative dosage units. If the composition provides a delayed release of the pharmacologically active agent, the amount of PTH may also be above the effective amount. The total amount of PTH to be used can be determined by methods known in the art. Generally, however, a satisfactory systemic result will be obtained at a daily dose of about 0.001 μg to about 10 mg / kg animal body weight, preferably 1 μg to about 6 μg / kg body weight.

Appropriate dosages of calcitonin to be administered will of course depend on, for example, the amount of PTH to be administered and the severity of the condition being treated. Generally, however, a satisfactory systemic result will be obtained at a daily dose of about 0.5 μg to about 10 μg / kg animal body weight, preferably 1 μg to about 6 μg / kg body weight.

Oral administration may be performed regularly, such as at least once daily or weekly; Intermittently, such as irregularly for one day or one week; Or periodically, for example, during periods of several days or weeks, followed by periods of no administration.

Co-administration of PTH and calcitonin includes simultaneous mono, simultaneous or continuous administration of two compounds. Simultaneous mono administration means administering two compounds in the form of a single dose; Simultaneous heterologous administration means administration of two compounds in separate dosage forms but at about the same time; Continuous administration means administration of another species after administration of one compound. Continuous administration may result in simultaneous mono or simultaneous heterologous dosage forms of the two compounds, followed by discontinuation of simultaneous mono or simultaneous heterologous administration, followed by administration of one of the two compounds alone and continuously.

Oral administration of PTH and calcitonin according to the present invention can be accomplished in any known manner, such as in liquid or solid dosage forms.

Liquid dosage forms include solution emulsions, suspensions, syrups and elixirs. In addition to PTH and / or calcitonin, liquid formulations also include inert excipients commonly used in the art, such as solubilizers such as ethanol; Oils such as cottonseed, castor and sesame oils; Wetting agents; Emulsifiers; Suspending agents; Sweeteners; Flavoring agents; And solvents such as water.

Solid dosage forms include capsules, soft-gel capsules, tablets, caplets, powders, granules or other solid oral dosage forms, all of which may be prepared by methods well known in the art. In addition to PTH and / or calcitonin, these solid dosage forms generally include pharmaceutically acceptable delivery agents for PTH and / or calcitonin.

Suitable delivery agents are any one of the 123 modified amino acids disclosed in US Pat. No. 5,866,536 or any one or any combination of the 193 modified amino acids described in US Pat. No. 5,773,647. The contents of the aforementioned U.S. Patent Nos. 5,773,647 and 5,866,536 are hereby incorporated by reference in their entirety. In addition, the delivery agent may be the disodium salt of any of the aforementioned modified amino acids, as well as ethanol solvates and hydrates thereof. Suitable compounds include compounds of formula (I)

In the formula,

R ¹ , R ² , R ³ and R ⁴ are independently hydrogen, —OH, —NR ⁶ R ⁷ , halogen, C ₁ -C ₄ alkyl or C ₁ -C ₄ alkoxy;

R ⁵ is substituted or unsubstituted C ₂ -C ₁₆ alkylene, substituted or unsubstituted C ₂ -C ₁₆ alkenylene, substituted or unsubstituted C ₁ -C ₁₂ alkyl (arylene), or substituted or unsubstituted Aryl (C ₁ -C ₁₂ alkylene);

R ⁶ and R ⁷ are independently hydrogen, oxygen or C ₁ -C ₄ alkyl; And hydrates and alcohol solvates thereof. The compounds of formula (I) as well as their disodium salts and their alcohol solvates and hydrates are described in WO 00/059863 together with their preparation.

Preferred delivery agents are N- (5-chlorosalicyloyl) -8-aminocaprylic acid (5-CNAC), N- (10- [2-hydroxybenzoyl] amino) decanoic acid (SNAD), N- ( 8- [2-hydroxybenzoyl] amino) caprylic acid (SNAC) and monosodium and disodium salts thereof, ethanol solvates of sodium salts thereof and monohydrates of sodium salts thereof, and any combination thereof. Most preferred delivery agents are the disodium salt of 5-CNAC and its monohydrate.

Pharmaceutical compositions of the invention typically contain a delivery effective amount of one or more delivery agents, ie an amount sufficient for delivery of PTH and / or calcitonin for the desired effect. Generally, the delivery agent is present at 2.5 to 99.4 weight percent, more preferably 25 to 50 weight percent of the total composition.

The compositions may be pH adjusters, preservatives, flavors, taste-masking agents, fragrances, wetting agents, tonicifiers, colorants, surfactants, plasticizers, lubricants such as magnesium stearate, flow aids, compression Aids, solubilizers, excipients, diluents such as microcrystalline cellulose, such as Avicel PH 102 supplied by FMC Corporation, or any combination thereof, including but not limited to additives of conventional usage It can be included as. Other additives may include phosphate buffer salts, citric acid, glycols and other dispersants.

The composition also includes one or more enzyme inhibitors, such as actinin or epiactinin and derivatives thereof; Aprotinin, trasylol, and Bowman-Birk inhibitors.

In addition, transport inhibitors, ie, p-glycoproteins such as ketoprofin, may be present in the compositions of the present invention.

The solid pharmaceutical composition of the present invention may be further subjected to conventional methods such as after molding, instead of blending, kneading, filling into a capsule, or filling into a capsule, or blending an active agent or a mixture of active agents, delivery agents and any other ingredients. It can be prepared by tableting or compression-molding to obtain tablets. In addition, the solid dispersion may be formed by known methods and then further worked to form tablets or capsules.

Preferably, the components of the pharmaceutical composition of the present invention are mixed homogeneously or uniformly throughout the solid dosage form.

Oral administration of the present invention may be performed on any animal in need of treatment, including but not limited to mammals such as rodents, cows, pigs, dogs, cats and primates, especially humans.

The following examples are provided to further illustrate the present invention.

Example 1

The following capsules were prepared as follows:

Capsule prepared from 5-CNAC disodium salt 400 mg / sCT 800 mcg / PTH 800 mcg (Capsules 1A)

Capsule prepared from 5-CNAC disodium salt 400 mg / PTH 800 mcg (Capsules 1 B)

Capsule prepared from 5-CNAC disodium salt 400 mg / sCT 800 mcg (capsules 1 C)

Capsule made from PTH 800 mcg (Capsules 1 D)

PTH is PTH fragment 1-34 and was commercially available. sCT was salmon calcitonin. Capsules were all prepared as dry blends by weighing each component and blending them together to make a homogeneous mix, then manually filling 400 mg of the mix into each capsule. For capsules with PTH alone, PTH was weighed and 400 mg was put directly into each capsule.

Example 2

Primate administration

The capsules prepared in Example 1 were administered to Rhesus monkeys as follows: A group of four monkeys each received one capsule prepared as in Example 1 as follows:

Rhesus macaques were fasted overnight before taking them and completely consciously locked in chairs during the study. The capsules were administered via a gavage tube followed by 10 mL of water.

Blood samples were taken at 0, 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 5 and 6 hours after administration. Plasma salmon calcitonin and plasma PTH were measured by radioimmunoassay. Primate plasma salmon calcitonin (sCT) and PTH results from each group of monkeys were averaged and the highest average plasma calcitonin was calculated and reported in Tables 1-5 below.

As can be seen from the data in Tables 1-5, sCT and PTH plasma levels were essentially the same whether the compounds were administered separately or together. However, oral administration of a combination of PTH and calcitonin resulted in very surprisingly reduced serum calcium concentrations than levels obtained using calcitonin alone while PTH and calcitonin plasma concentration levels were similar to those achieved when administered with each agent alone.

The above embodiments and examples are given merely to illustrate the invention and are not intended to be limiting. Many other embodiments and variations are within the scope of this invention and will be readily available to those skilled in the art.

Claims (13)

A method of oral administration of an effective dose of PTH, comprising oral coadministration of an effective amount of PTH and an effective amount of calcitonin to a patient in need thereof. The method of claim 1, wherein the calcitonin is salmon calcitonin. A method of stimulating new bone formation, comprising orally administering a therapeutically effective amount of PTH and a therapeutically effective amount of calcitonin to a patient in need of new bone formation. The method of claim 3, wherein the calcitonin is salmon calcitonin. A method of treating or preventing osteoporosis, comprising orally administering a therapeutically effective amount of PTH and a therapeutically effective amount of calcitonin to a patient in need thereof. The method of claim 5, wherein the calcitonin is salmon calcitonin. Composition for oral administration comprising PTH and calcitonin. 8. The composition of claim 7, wherein the PTH is human form of PTH. The composition of claim 8 wherein the calcitonin is salmon calcitonin. Use of PTH and calcitonin to prepare orally administrable medicaments for stimulating bone formation. Use according to claim 10, wherein the PTH is human form of PTH. Use according to claim 11, wherein the calcitonin is salmon calcitonin. A new kit for stimulating bone formation comprising PTH and calcitonin suitable for oral administration along with instructions for oral administration thereof.